Therapeutic Processes in a School-Based Intervention for High School Students With Attention-Deficit/Hyperactivity Disorder

Therapeutic processes are important in potentially facilitating psychosocial treatment outcomes. Our aim in this study was to evaluate clinician skills and behaviors (i.e., clinician adherence, clinician competence) and relational factors (i.e., working alliance, adolescent treatment engagement) as predictors of academic and organizational skill outcomes in a school-based, multicomponent skills training intervention for 84 high school students (83.3% male, M-age = 15.0, SD = 0.8) with attention-deficit/hyperactivity disorder. Clinician adherence and competence as well as working alliance, after controlling for baseline functioning and other therapeutic processes, did not account for a significant amount of variance for any treatment outcome. Alternatively, adolescent engagement emerged as a predictor of parent ratings of organizational skills and homework performance at posttreatment. These findings highlight treatment engagement as a key component in the mechanisms of effects in skills training interventions for adolescents with attention-deficit/hyperactivity disorder and important areas for assessment (e.g., measurement of engagement) and implementation support (e.g., training in engagement enhancement strategies) in school-based mental health practice at the secondary level.